Keeping Our Eye on Access to Care

Mario Motta, M.D., a Salem cardiologist and president of the Massachusetts Medical Society offers a reminder that universal coverage doesn't always translate into universal access:

Massachusetts continues to attract attention as a model for the nation in health care reform, and the analysis and commentary, both good and bad, on our experience keeps flowing from a variety of sources.

In a September 30 commentary in The Christian Science Monitor, entitled “Health care in Massachusetts: A warning for America,” Denver physician Paul Hsieh provides a litany of negatives about health reform in the Commonwealth and seeks to dissuade the nation from copying our model in any way, shape or form. Some excerpts:

“Rather that creating a utopia of high-quality affordable healthcare, the result has been the exact opposite – skyrocketing costs, worsened access, and lower quality care…..The Massachusetts plan thus violates the individual’s right to spend his own money according to his best judgment for his own benefit….The Massachusetts plan is also breaking the state budget.”

A study in Health Affairs published October 1, “Employer Coverage from Employees’ Perspective,” provides some good news. It found that “employer-sponsored health insurance coverage has remained strong under health reform in Massachusetts.” The survey found more workers reporting an insurance offer from their employer and more workers taking up that offer in the fall of 2008 that before health reform. “Overall,” the study concluded, “these findings provide evidence of Massachusetts employers’ commitment to providing access to high-quality employer coverage under health reform, despite the beginning of the economic downturn.”

Readers can judge for themselves about the intent and accuracy of those analyses and others on the Massachusetts experience. The fact is we’ve made progress with our health care reform: more residents than ever before are now insured, and many of those are now able to see physicians and get care they’ve been without for far too long. And that is very good news.

Huge issues remain, of course, with cost and quality among those at the top of the list, and we have been forced to deal with those in an unusually tough economic environment.

While we’re hard at work addressing those, let’s not forget one of the major lessons learned from our health reform experience: universal coverage doesn’t equate to universal access.

The crisis in access to care, particularly primary care, was once again highlighted by the Massachusetts Medical Society’s 2009 Physician Workforce Study. This eighth annual and latest study showed an ever-more deteriorating condition of primary care. Shortages in primary care physicians appeared for the fourth year in a row (commentators please note that the shortages began before universal health reform was established), and the percentage of primary care practices closed to new patients is the highest it’s ever been as recorded by the Society. Additionally, shortages of obstetricians/gynecologists have appeared for the first time, adding to primary care difficulties, as many women use this specialty for primary care.

While the study did have some good news – five physician specialties were taken off the “short list” –the primary care situation is cause for alarm, for it is primary care that provides patients a gateway to the healthcare system and is the mainstay of preventive care and wellness.

The legislature has recognized the critical nature of the physician workforce and has seen fit to establish several initiatives to bolster the workforce as part of health care reform legislation. Chapter 305 of the Acts of 2008 provides for those initiatives, but budget cuts have delayed implementation and reduced resources available for them. While legislators, industry leaders, policymakers and providers struggle with the immediate challenges of revenue shortfalls, more budget cuts, and resolutions to cost and quality issues, let’s keep in mind the critical aspect of access to care. Ways to improve access to care must be part and parcel of health reform. Our patients are depending on it.